WHO issues new and
updated
recommendations on
treatment of mental,
neurological and
substance use conditions
20 November 2023
Departmental news
Reading time: 3 min (909 words)
The World Health Organization (WHO) has today published the third edition of
the Mental Health Gap Action Programme (mhGAP) guideline which includes important
new, and updated, recommendations for the treatment and care of mental, neurological
and substance use (MNS) disorders.
MNS disorders are major contributors to morbidity and premature mortality in all
regions of the world. Yet it is estimated that over 75% of people with MNS disorders are
unable to access the treatment or care they need.
The mhGAP guideline supports countries to strengthen capacity to deal with the
growing burden of these conditions. It is intended for use by doctors, nurses, other
health workers working in non-specialist settings at primary health care level, as well as
health planners and managers.
“For 15 years, mhGAP has played a vital role in improving access to evidence-based
psychological interventions and medicines for the treatment and care of people with
mental, neurological and substance use disorders. Considering the growing relevance of
mental health, this evidence-based guide is more important than ever in supporting
primary health care workers to treat people with MNS disorders,” said Dévora Kestel,
WHO Director for Mental Health and Substance Use.
The 2023 guideline update includes 30 updated and 18 new recommendations related
to MNS conditions, alongside 90 pre-existing recommendations.
New recommendations on anxiety disorders
The guideline contains a new module on anxiety reflecting the increased number of
people with anxiety disorders, which are among the world’s most common mental
disorders. The module includes the following recommendations:
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Psychological interventions based on cognitive behavioural therapy (CBT) should be
offered to adults with generalized anxiety disorder and/or panic disorder. These
interventions can be offered in a variety of formats including online, in-person, in
groups, or self-guided.
Stress management techniques should be considered for adults with generalised
anxiety and/or panic disorder.
Selective Serotonin Reuptake Inhibitors (SSRIs) should be considered for treating
adults with generalized anxiety and/or panic disorder.
Psychological and psychosocial interventions
The guideline sets out the continuing importance of psychological treatments for a
range of MNS conditions.
The mhGAP guideline contains new recommendations on psychosocial interventions for
carers of persons with psychosis or bipolar disorder as well as new recommendations on
psychosocial interventions for psychosis, alcohol dependence, substance use, dementia,
and children and adolescents with neurodevelopmental disorders including autism,
ADHD and cerebral palsy.
Women and girls who want to become pregnant or may become pregnant should
not use valproic acid (sodium valproate)
The guideline contains an updated recommendation which advises against the use of
valproic acid (sodium valproate), a medicine for the treatment of epilepsy and bipolar
disorder, due to risk of birth defects if taken during pregnancy.
The guideline recommends the following:
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Valproic acid (sodium valproate) should not be prescribed to women and girls who
want to become pregnant or may become pregnant because of the high risk of
birth defects and developmental disorders in children exposed to valproic acid in
the womb.
For women and girls currently prescribed valproic acid (sodium valproate), advice
should be provided on use of effective contraception.
It is important that women and girls do not stop taking valproic acid (sodium
valproate) without first discussing it with their doctor.
Women should be advised to consult their physician as soon as they are planning
pregnancy and the need to urgently consult their physician in case of pregnancy.
Every effort should be made to switch to appropriate alternative treatment prior to
conception.
A specialist should periodically review whether valproic acid (sodium valproate) is
the most suitable treatment for the person.
The guideline reflects the WHO safety statement issued in May 2023 on the use of
valproic acid (sodium valproate) for the treatment of epilepsy and bipolar disorder in
women and girls of childbearing potential. This was discussed at the meeting of the
WHO Advisory Committee for the Safety of Medicinal products (ACSoMP) [2022
December ACSoMP recommendations]. A safety statement was also added to the
Essential Medicines List (EML).
Other recommendations:
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Digitally-delivered psychological and psychosocial interventions feature across
multiple modules - alcohol use disorders, anxiety, conditions related to stress, drug
use disorders, and self-harm and suicide
Recommendations for non-pharmacological interventions to improve outcomes for
people with dementia have been updated to include physical exercise, CBT,
cognitive stimulation therapy and cognitive training.
The antipsychotic medicines quetiapine, aripiprazole, olanzapine, paliperidone, and
the long-acting antipsychotics haloperidol and zuclopenthixol are included for
treatment of psychosis and bipolar disorder. Levetiracetam and lamotrigine are
included for treatment of epilepsy.
Notes to Editors:
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First published in 2010 and last updated in 2015, the mhGAP guideline, and its
associated products including the mhGAP intervention guide, are now used in more
than 100 countries and available in over 20 languages.
The mhGAP guideline was updated in accordance with the WHO handbook for
guideline development and meets international standards for evidence-based
guidelines. In collaboration with the Guideline Development Group (GDG), the
Topic Expert Groups (TEGs) and the guideline methodologist, the WHO Steering
Group identified priority questions and outcomes to determine those that were
critical for the update of the mhGAP guideline. Systematic evidence reviews were
used to develop the Evidence to Decision and Summary of Findings tables,
according to the Grading of Recommendations Assessment, Development and
Evaluations (GRADE) approach. The GDG, developed recommendations that
considered a range of elements, namely: the certainty of the evidence; the balance
between desirable and undesirable effects; values and preferences of intended
users of the intervention; resource requirements and cost-effectiveness; health
equity, equality and non-discrimination; feasibility; human rights and sociocultural
acceptability.